Effectiveness of temple-based stroke education program for risk reduction and promoting appropriate emergency response after acute stroke among Buddhist elderly in Uttaradit province Thailand

Abstract

Background: In Christianity, the church-based was the one key element for stroke education which may help to reduce stroke risk. However, within a Buddhist setting, being the major religion among the Thai population, no study of religious based stroke education has previously been undertaken. Objectives: To determine the effectiveness of a temple-based stroke education program (T-SEP) among the Thai Buddhist elderly in Uttaradit province in 1) improving knowledge, awareness and health behavioral changes on stroke risk reduction; 2) reducing blood pressure, serum total cholesterol, glycated hemoglobin and body mass index, and 3) improving knowledge and awareness of appropriate emergency response after acute Methods: A quasi-experimental design was adopted. The study comprised of: 1) the intervention group (Lablae district) and 2) the control group (Tron district) from Uttaradit province. Both groups were consisted of the representatives of the respective districts totaling 73 persons aged 60 years and above, both male and female. The eligibility requirements for inclusion were usually engaged in temple attendance at least once a month and had at least one factor of stroke risk such as high blood pressure, high cholesterol, diabetes or obesity. Quantitative and qualitative data were obtained at baseline and six months after the intervention. Temple-based stroke education program (T-SEP) consisted of the knowledge on: 1) stroke risk and the method of modifying behaviors for risk reduction, and 2) appropriate emergency response after acute stroke. Representative members of the temple committee in the intervention group were trained to be program educators from the stroke experts after which they attended at the temples to promote stroke education for the elderly. Results: Statistically significant differences on knowledge, awareness and behavioral changes of stroke risk reduction were found between intervention and control group. The behaviors on stroke risk such as salt intake, fat intake, sugar intake, vegetables or fiber intake and exercise/ physical activity among participants of the intervention group were found to have improved more than that compared to the control group (P value = < .001, < .001, < .001, < .05 and < .05 respectively). In addition, systolic blood pressure, serum total cholesterol, glycated hemoglobin and body mass index in the intervention group were found to be lower than that of the control group (P < .05). Moreover, the awareness of appropriate emergency response after acute stroke among participants of the intervention group were found to be higher than compared to the control group (P < .001). Conclusion and discussion: Temple-based stroke education program (T-SEP) conducted over a six month period had a sustained effect in significant clinical reduction in the risk of stroke and improved knowledge, awareness and health behavior changes of stroke risk among the Thai Buddhist elderly in Lablae district, Uttaradit province. Moreover, the T-SEP intervention was found to help in increasing awareness of appropriate emergency response after acute stroke. Policy: Health providers should consider including an advocacy T-SEP for adapting regular Buddhist elderly temple practice in the protocols for stroke risk patients such as high blood pressure, high cholesterol, diabetes and obesity for future stroke risk reduction and it should include the knowledge of appropriate activation of emergency response after acute stroke among Buddhist elderly.